Immunization is an effective strategy to reduce illness and death from pneumococcal pneumonia and influenza, yet these two illnesses are the leading cause of death from preventable disease among older Americans, particularly in Long Term Care Facilities (LTCFs) This study will describe immunization processes and procedures in a national sample of LTCFs and examine staff knowledge, attitudes, practices and decision making regarding LTCF resident immunization delivery. It will also describe the collection and documentation of race and ethnicity information, and evaluate the validity of race reported on the resident assessment instrument. Lastly, this study will examine how race might play a role in the immunization rates of LTCF residents. A Technical Advisory Panel (TAP) comprised of five experts in the areas of long term care, infection control and ethnic diversity will inform the study. Under their guidance, a National Administrative Survey will be sent to LTCFs to collect demographic data and gather information on the policies and procedures facilities have in place to deliver immunizations to residents and document the resident's race. Staff at a stratified random sample of 36 sites responding to the National Administrative Survey will be surveyed to explore their knowledge base, attitudes and practices in relation to the immunization of nursing home residents and the recording of their race. In addition, focus groups will be conducted on-site with LTCF staff to gather in-depth information on these practices as well as the problems, concerns and barriers regarding the effective and equitable implementation of immunization and racial identification practices. While on-site, Joint Commission project staff will also abstract data on resident immunizations and race from both the medical record and MDS, and calculate agreement rates. Patients will also be asked to self-identify their racial heritage and their responses will be compared to the information in the medical record. Finally, data will be analyzed to examine the association between race and immunizations. The results of the study will be described in a manuscript prepared for peer review that will identify reasons race might play a role in the immunization rates of LTCF residents. PUBLIC HEALTH RELEVANCE: The disparity in immunization rates between racial and ethnic groups is well-documented. The validity of documentation of race and ethnicity, however, still needs to be established. Factors that influence patient acceptance of immunizations are also well known, but little is known about factors that influence how, when, and to whom staff offers immunizations. The value of this project is in establishing the validity of influenza status and race reported on the MDS and identifying whether race might influence immunization rates of LTCF residents.